PLEASE TYPE

Name______________________________________                 Date____________________
                Last                First                 Middle

Home Address_______________________________________     Soc. Sec. No._______________

Street______________________________________________     

Phone___________________________               _____________________________
                          (Home)                                                       (Office)

Office or School Address_______________________________    Date of Birth_______________

Street______________________________________________

City, State, Zip__________________________________________________  

Mailing Preference (Circle one)    Home   Office 

DATE WORK HISTORY: FULL TIME ONLY
FROM
(YEAR) 		TO
(YEAR) 		CHURCH/EMPLOYER CITY, STATE TITLE/TYPE OF WORK
         
         
         
         
         
         
         


DATE WORK HISTORY: RELEVANT PART-TIME OR VOLUNTEER
 (Do not include service to the church)
FROM
(YEAR) 		TO
(YEAR) 		CHURCH/EMPLOYER CITY, STATE HRS PER
WK/MO 		TITLE/TYPE OF WORK
           
           
           
           
           
           


DATE SERVICE TO THE CHURCH
FROM
(YEAR) 		TO
(YEAR) 		CHURCH/EMPLOYER CITY, STATE HRS PER
WK/MO 		TITLE/TYPE OF WORK
           
           
           
           
           


DATES ATTENDED FORMAL EDUCATION
FROM
(YEAR) 		TO
(YEAR) 		COLLEGE, UNIVERSITY
THEOLOGICAL SEMINARY 		CITY, STATE DEGREE/
DIPLOMA 		SPECIALIZATION
           
           
           
           
           
           
           
           


Successful completion of the degrees above must be verified. Please include with your application a letter from each college, university or theological seminary on its stationery and with its stamp or seal documenting degrees listed above.

OTHER PROFESSIONAL OR TECHNICAL CERTIFICATION OR ACCREDITATION

ECCLESIASTICAL STATUS (Please check and fill in as appropriate):

Local Church Membership:_____________________________________________________

Mailing Address:_____________________________________________________________

Presbytery ___________________________Synod__________________________________

[   ] Ordained Minister, Date Ordained ________________

Presbytery Membership ____________________

REFERENCES (List 4-6 persons who are in a position to give an objective evaluation of your training, experience and capabilities. This list must include your present minister and a minister or elder of your most recent previous position if you have served your present church less than five years.)

REFERENCES
NAME COMPLETE ADDRESS PHONE (include Area Code)
   

 
 
  		 
 
  		 
 
  		 
 
  		 
 
  		 


I hereby authorize those inquiring into my suitability for accreditation to make inquiry of the above listed persons.

Date ______________________  

Signature__________________________________________________ 


All Certification forms need to be mailed to the PAM National Office:
      Presbyterian Association of Musicians
      100 Witherspoon Avenue
      Louisville, KY 40202-1396

For questions please call the PAM National Office at 502-569-5288 (toll free) 1-888-728-7228 xt. 5288



Revised 11/2002